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This category contains 46 posts

The Dollars and Cents of Eating Disorders

I must admit that I cringe slightly every time I try to think about healthcare from an economics perspective. To me, this comes a little close to putting a dollar value on human beings, which feels uncomfortably post-humanistic to me. Nonetheless, there is no ignoring the ways in which economic concerns factor into policy decisions that drive our human services, including health care.

There are also a number of pragmatic reasons for thinking about the costs associated with illnesses; talking in dollars and cents can make for a convincing argument when seeking funding to do research on a particular illness, for example. The ability to reduce healthcare costs is incredibly compelling in a time of fiscal restraint.

Crow (2014) published a short article about the economic costs of eating disorder treatment. In this article, he highlights some recent studies that have examined factors related to “the economics of eating disorders” and suggests avenues for future research in this area.

I will preface my analysis by noting that healthcare economics are not my area of expertise, and I doubt …

Hypermetabolism in Anorexia Nervosa

Weight restoration is a crucial component of anorexia nervosa treatment. It is a challenging process for a multitude of reasons. Adding to the complexity and the challenge is the fact that during weight restoration, individuals with anorexia nervosa tend to require increasingly more calories to maintain the same rate of weight gain.

That is, individuals need to continually increase their caloric intake, in steps, sometimes upwards of 100 calories (technically, kilocalories) per kilogram per day, to continue gaining weight. For instance, an individual weighing 45 kg may need to eat 4,500+ calories to continue gaining 1-1.5kg (2.2-3.3lbs) a week. Indeed, studies have found that standard resting energy expenditure (REE) equations tend to overestimate caloric needs at the beginning of refeeding but underestimate them in the later stages (Forman-Hoffmann et al. 2006; Krahn et al., 1993).

After achieving a healthy weight, individuals recovering from anorexia nervosa still typically need to eat more calories to maintain their new healthy weight — more than healthy individuals of the same weight who do not have eating disorder histories — usually at

Disordered Eating and Athletic Performance: Where’s the Line?

If a person severely restricts his diet and exercises for hours each day, he has an eating disorder. If another does exactly the same but it is because she wants to make the lightweight rowing team (which has an upper weight limit), she’s a committed athlete. When the two overlap, and an athlete presents with eating disorder symptoms, how do we distinguish between the demands of the sport and the illness?

I’ve been interested in the distinctions we make between disordered and non-disordered eating and exercise behaviours for a while now. Recently, when I was browsing through articles, I came across a literature review by Werner et al. (2013) (open access) of studies examining weight-control and disordered eating behaviours in young athletes.

The authors start by noting the sheer lack of research that has actually been done in this area. This is worrying: typical onset of eating disorders is during adolescence, and research indicates that athletes are more likely to develop these disorders, leaving young athletes in what appears to be a high-risk position.

WHICH ATHLETES?

Werner et al. searched …

In a Relationship and It’s Complicated: Eating Disorders in Intimate Relationships

What would you do if your partner started restricting caloric intake or bingeing and purging? Would you know how to approach your partner, how to offer support? And what about your own mental health?

Coping with an eating disorder in the context of any relationship can be tricky. There is a growing body of literature that addresses ways to bolster support for caregivers. While this is encouraging, a number of these studies explore the experiences of “caregivers” as a generic category encompassing parents, spouses, and other relatives. Few studies focus on the experiences of spouses and significant others in particular.

Dick, Renes, Morotti & Strange (2013) looked at literature exploring eating disorders in the couple context in an effort to devise recommendations for clinicians working with couples. For their review, the authors honed in on the experiences of heterosexual couples where the female partner was diagnosed with anorexia nervosa or bulimia nervosa.

I suspect that these decisions were largely pragmatic: it would be more difficult to compare across studies highlighting the experiences of a more diverse sample. …

Is Eating Disorder Prevention Possible?

How did I ever find things to write about before social media? Recently, someone on Tumblr asked whether eating disorder prevention and awareness efforts do more harm than good. In other words, can attempting to prevent eating disorders actually contribute to their development? Good question, I thought. I’ve often wondered about this myself, especially in light of some emerging studies suggesting that “healthy eating” campaigns may actually contribute to unhealthy (restrictive) behaviours around food in school children. So off I went to scour the literature. I came up with a number of hits, but surprisingly few from the past few years. With this recent silence in mind, I will look specifically at a meta-analysis by Stice, Shaw & Marti published in 2007 that highlights some of the characteristics of effective prevention programs and comment on some of the potential pitfalls of prevention.

PREVENTION

As a bit of a primer prevention efforts are generally divided into 3 types: primary, secondary and tertiary.

  • Primary prevention includes efforts to prevent the disorder/disease/condition from occurring in the first place; essentially, it looks to intervene

The Art of Therapy: Using of Arts-Based Therapies in Eating Disorder Treatment

Arts-based therapies are often used to supplement more “traditional” eating disorder treatment protocols in various different settings, ranging from individual therapy to inpatient units. However, as Frisch, Franko & Herzog (2006) note, no published research provides empirical support for the use of arts-based therapies for eating disorder treatment.

You might be wondering: if there is no empirical support, why are clinicians still using these therapeutic practices? You might also be wondering why I’ve chosen to dissect an article from 2006.

I’ll address the first question in this post (teaser: it’s really hard to say!). As for my delving back into the depths of academia, there is surprisingly little literature that touches on arts-based therapy, despite its continued use. This article provides an overview of why this might be, and where we can go from here.

WHAT IS ARTS-BASED THERAPY?

Arts therapy is an umbrella term used to refer to the “medicinal use of creative arts,” including dance and movement, drama, music, and visual arts. The premise of arts-based therapy is that engaging with the arts will facilitate clients’ …

Body Image: Is It a Useful Concept? (Maybe Not So Much)

I recently attended the International Society of Critical Health Psychology’s 8th Biennial Conference in Bradford, England. At the conference, I had the pleasure of attending many talks that challenged the way we approach health psychology. Luckily for me, there were several sessions that touched on issues of disordered eating and body image.

One such talk, a panel presentation with Hannah Frith, Sarah Riley, Martine Robson and Peter Branney, challenged attendees to re-think the way we approach body image. When I returned home, I immediately downloaded an article by Kate Gleeson and Hannah Frith (2006) that discusses this same idea and essentially begs the question: Is the concept of “body image,” as it is currently articulated, actually useful?

This might come off as a controversial question; after all, body image is central to many studies (and treatment programs) related to eating disorders. We’re told repeatedly that by improving our body image, we can achieve peace with food, with ourselves, with exercise, and with others. Good body image is upheld as the panacea of …

Excessive, Obsessive, Compulsive? The Links Between OCD, OCPD and Excessive Exercise in Anorexia Nervosa

Excessive exercise played a big role in my eating disorder and, predictably, I am drawn to studies that look at the role excessive exercise plays in eating disorder symptomatology, course and outcome. This topic has captured the interest of many eating disorder researchers, with studies revealing that up to 80% of individuals with anorexia nervosa may exercise excessively (Davis et al., 1997), though others suggest more modest statistics, around 39% (Shroff et al., 2006; Tetyana wrote a post about this article here).

Scholars have also noted the potentially obsessive and compulsive nature of exercise among some individuals with eating disorders and have made the natural transition toward examining whether links exist between excessive exercise and obsessive-compulsive disorder (OCD) and/or obsessive-compulsive personality disorder (OCPD) traits (If you are confused about the difference between OCD and OCPD, click here). Young, Rhode, Touyz & Hay (2013) conducted a rigorous systematic review to synthesize and draw conclusions from the results of such studies.

The authors aimed to clarify the links between both OCPD traits and …

The Enigmatic Persistence of Anorexia Nervosa

Anorexia nervosa was first described in the medical literature in 1689 by Richard Morton. It has been over 300 years since then and AN continues to be one of the deadliest psychiatric disorders. If not treated early, it runs the risk of becoming deeply entrenched and highly resistant to treatment.

Moreover, established treatments for related disorders like bulimia nervosa and depression, such as cognitive behavioural therapy and antidepressants, are rather ineffective in treating anorexia nervosa. Finally, even if significant physical and mental improvements are achieved in treatment, relapse rates for older individuals (even those in their 20s) remain high.

What makes anorexia nervosa so persistent and so hard to treat in individuals who develop it, particularly if it is not treated soon after onset? Why is recovery so hard?

In this paper, B. Timothy Walsh outlines a model based on cognitive neuroscience that attempts to answer these questions:

Its central element is that this behavior has become habitual and is grounded in the neural mechanisms that underlie habit formation and persistence. This formulation is based on a substantial body

Beyond Simple Solutions: The Need for Complex Ideas in Anorexia Nervosa

I often hesitate to make broad, sweeping claims about the nature, cause, and experience of eating disorders and disordered eating. However, if there is one thing I feel absolutely certain saying about these disorders, it is that they are incredibly complex and multifaceted with no “one-size fits all” solution. So, I was quite excited when I came across a recent article by Michael Strober and Craig Johnson (2012) that explores the complexity of eating disorders and their treatment. Both authors have significant clinical experience treating eating disorders.

This article uses cases studies, literature, and the authors’ collective clinical experience to respond to some of the key controversies surrounding anorexia and its treatment. Among the major controversies that have come to light of late, they focus on two:

  1. Genetic/biological causation (Biologically-based mental illness – BBMI)
  2. Family-based treatment (FBT) as the best form of treatment for adolescents

The authors’ exploration of these topics supports an overall argument: focusing on singular explanations and solutions for anorexia, particularly through the vehement defense of any particular approach, obscures the complexity of the disorder, as well …

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